1
|
Carbone S, Berta W, Law S, Kuluski K. Long-term care transitions during a global pandemic: Planning and decision-making of residents, care partners, and health professionals in Ontario, Canada. PLoS One 2023; 18:e0295865. [PMID: 38100397 PMCID: PMC10723734 DOI: 10.1371/journal.pone.0295865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
The COVID-19 pandemic appears to have shifted the care trajectories of many residents and care partners in Ontario who considered leaving LTC to live in the community for a portion or the duration of the pandemic. This type of care transition-from LTC to home care-was highly uncommon prior to the pandemic, therefore we know relatively little about the planning and decision-making involved. The aim of this study was to describe who was involved in LTC to home care transitions in Ontario during the COVID-19 pandemic, to what extent, and the factors that guided their decision-making. A qualitative description study involving semi-structured interviews with 32 residents, care partners and health professionals was conducted. Transition decisions were largely made by care partners, with varied input from residents or health professionals. Stakeholders considered seven factors, previously identified in a scoping review, when making their transition decisions: (a) institutional priorities and requirements; (b) resources; (c) knowledge; (d) risk; (e) group structure and dynamic; (f) health and support needs; and (g) personality preferences and beliefs. Participants' emotional responses to the pandemic also influenced the perceived need to pursue a care transition. The findings of this research provide insights towards the planning required to support LTC to home care transitions, and the many challenges that arise during decision-making.
Collapse
Affiliation(s)
- Sarah Carbone
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susan Law
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| |
Collapse
|
2
|
Allen J, Woolford M, Livingston PM, Lobchuk M, Muldowney A, Hutchinson AM. Informal carer support needs, facilitators and barriers in transitional care for older adults from hospital to home: A scoping review. J Clin Nurs 2023; 32:6773-6795. [PMID: 37272211 DOI: 10.1111/jocn.16767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 04/06/2023] [Accepted: 05/12/2023] [Indexed: 06/06/2023]
Abstract
AIM To synthesise evidence about informal carers' (carers) experience of their support needs, facilitators and barriers regarding transitional care of older adults with multimorbidity. BACKGROUND Carers provide crucial support for older adults during care transitions. Although health practitioners are well positioned to support carers, system factors including limited healthcare resources can compromise the quality of care transitions. DESIGN Scoping review. METHODS Searches were undertaken of the published literature. Five databases were searched including MEDLINE, CINAHL, EMBASE, PsycINFO and the Cochrane Library. Two reviewers independently screened articles to identify relevant studies. Studies were retrieved from January 2000 to July 2022. Data were extracted and tabulated for study characteristics, support needs, facilitators and barriers. Key themes and patterns were synthesised across the studies. RESULTS Eighteen studies including N = 3174 participants were retrieved. Most studies (n = 13) employed qualitative designs. Five studies used surveys. Carers reported their need to: be involved in coordinated discharge planning; advocate and be involved in decision-making; and receive community-based follow-up. Carers described facilitators and barriers in four themes: (1) relationships with the older adult and health practitioners, (2) being involved in coordinated discharge planning; (3) communication and information strategies; and (4) community-based follow-up. Synthesis of themes across all studies resulted in the identification of five areas of research: carers' health literacy; community-based care; carers' involvement in transitional care planning; inpatient and community health practitioners' communication skills; and culturally diverse carers' experiences. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE The review highlights the importance of quality communication and relationships between carers, older adults, health practitioners and health organisations. Although information and education are important there is a need for further research to examine systems that support communication between carers, older adults and health practitioners and health literacy for all carers including culturally diverse carers.
Collapse
Affiliation(s)
- Jacqueline Allen
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Marta Woolford
- Health and Social Care Unit, Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | | | - Michelle Lobchuk
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anne Muldowney
- Older Person's Advocacy Network, Surry Hills, NSW, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
3
|
Allen J, Hutchinson AM, Brown R, Livingston PM. Improving transitional care communication for older Australians from hospital to home: Co-design of the TRANSITION tool. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4223-e4238. [PMID: 35507732 PMCID: PMC10084314 DOI: 10.1111/hsc.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 03/31/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
This study aimed to develop and evaluate a communication tool to guide transitional care for older patients. Using experience-based co-design, a communication tool resulted from the triangulation of data collected from three study phases. From 2015 to 2016, semi-structured interviews and co-design focus groups were undertaken with older patients, carers and healthcare practitioners across acute, rehabilitation and community settings. The evaluation phase, conducted in 2017-2018, involved use of the communication tool by healthcare practitioners in a multidisciplinary care team with older patients in acute care and semi-structured interviews with healthcare practitioners about the acceptability and feasibility of the tool. A total of 103 patients, carers and healthcare practitioners took part. In semi-structured interviews, patients and carers reported needing to become independent in care transitions, which was supported by discussing the transitional care plan with healthcare practitioners. Interviews with healthcare practitioners identified that their need for fast and safe care transitions was supported by team discussion and by engaging patients and carers in their transitional care plan. Co-design focus group participants identified principles guiding transitional care including patient-centred communication. Data collected from semi-structured interviews and co-design focus groups were used to develop a prototype communication tool to guide conversations about discharge care between healthcare practitioners and older patients. Following use, healthcare practitioners reported that the communication tool was feasible and acceptable although some nurses perceived that transitional care was not their role. The communication tool provides an evidence-based resource for ward nurses to support transitional care continuity in multidisciplinary models.
Collapse
Affiliation(s)
- Jacqueline Allen
- School of Nursing and MidwiferyMonash UniversityClaytonVic.Australia
| | - Alison M. Hutchinson
- School of Nursing and MidwiferyCentre for Quality and Patient Safety ResearchInstitute for Health TransformationDeakin UniversityGeelongVic.Australia
| | - Rhonda Brown
- School of Nursing and MidwiferyDeakin UniversityGeelongVic.Australia
| | - Patricia M. Livingston
- School of Nursing and MidwiferyCentre for Quality and Patient Safety ResearchInstitute for Health TransformationDeakin UniversityGeelongVic.Australia
| |
Collapse
|
4
|
Singh H, Tang T, Steele Gray C, Kokorelias K, Thombs R, Plett D, Heffernan M, Jarach CM, Armas A, Law S, Cunningham HV, Nie JX, Ellen ME, Thavorn K, Nelson MLA. Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review. JMIR Aging 2022; 5:e35929. [PMID: 35587874 PMCID: PMC9164100 DOI: 10.2196/35929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions. Objective To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions. Methods This 2-phase rapid review involved a selective review of providers’ roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults’ hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1. Results In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients’ status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions. Conclusions This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2020-045596
Collapse
Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,March of Dimes Canada, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kristina Kokorelias
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rachel Thombs
- Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Donna Plett
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Matthew Heffernan
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carlotta M Jarach
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alana Armas
- March of Dimes Canada, Toronto, ON, Canada.,Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Susan Law
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Jason Xin Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Moriah E Ellen
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Michelle LA Nelson
- March of Dimes Canada, Toronto, ON, Canada.,Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
5
|
Park CM, Han SJ, Lee JH, Lim J, do Moon S, Moon H, Lee SY, Kim H, Jang IY, Jung HW. A focus group interview with health professionals: establishing efficient transition care plan for older adult patients in Korea. BMC Health Serv Res 2022; 22:397. [PMID: 35337330 PMCID: PMC8957176 DOI: 10.1186/s12913-022-07802-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although transition care planning can affect the functional status and quality of life after acute hospitalization in older adults, little is known on problems associated with discharge planning in acute care hospitals in Korea. We aimed to investigate barriers and possible solutions on transfer planning of complex older patients in this study. Methods We used focus group interviews with the application of framework analysis. Twelve physicians providing inpatient care from 6 different institutions in Korea participated in the interview. Facilitating questions were extracted from 2 roundtable meetings prior to the primary interview. From transcribed verbatim, themes were constructed from corresponding remarks by participants. Results We revealed two main domains of the barrier, which included multiple subdomains for each of them. The first domain was a patient factor barrier, a composite of misperception of medical providers’ intentions, incomprehension of the healthcare system, and communication failure between the caregivers or decision-makers. The second domain, institutional factors included different fee structures across the different levels of care, high barrier to accessing health service in tertiary hospitals or to be referred to, the hardship of communication between institutions, and insufficient subacute rehabilitation service across the country. Conclusions Through the interview, physicians in the field recognized barriers to a smooth transition care process from tertiary level hospitals to community care, especially for older adults. Participants emphasized both the patients and hospital sides of adjustment on behaviors, communication, and greater attention for the individuals during the transition period.
Collapse
Affiliation(s)
- Chan Mi Park
- Harvard T.H. Chan School of Public Health, MA, Boston, USA
| | - Seung Jun Han
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea.
| | - Jae Hyun Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea
| | - Jin Lim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea
| | - Sung do Moon
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea
| | - Hongran Moon
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea
| | - Seo-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea
| | - Hyeanji Kim
- Regional Emergency Medical Center, Seoul National University Hospital, Seoul, Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul, 05556, Songpa-gu, Korea
| | - Hee-Won Jung
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Hospital Medicine Center, Seoul National University Hospital, Seoul, Korea. .,Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul, 05556, Songpa-gu, Korea.
| |
Collapse
|
6
|
Written discharge communication of diagnostic and decision-making information for persons living with dementia during hospital to skilled nursing facility transitions. Geriatr Nurs 2022; 45:215-222. [PMID: 35569425 PMCID: PMC9327092 DOI: 10.1016/j.gerinurse.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 01/26/2023]
Abstract
Hospital-to-skilled nursing facility (SNF) transitions constitute a vulnerable point in care for people with dementia and often precede important care decisions. These decisions necessitate accurate diagnostic/decision-making information, including dementia diagnosis, power of attorney for health care (POAHC), and code status; however, inter-setting communication during hospital-to-SNF transitions is suboptimal. This retrospective cohort study examined omissions of diagnostic/decision-making information in written discharge communication during hospital-to-SNF transitions. Omission rates were 22% for dementia diagnosis, 82% and 88% for POAHC and POAHC activation respectively, and 70% for code status. Findings highlight the need to clarify and intervene upon causes of hospital-to-SNF communication gaps.
Collapse
|
7
|
Kokorelias KM, DasGupta T, Hitzig SL. Designing the Ideal Patient Navigation Program for Older Adults with Complex Needs: A Qualitative Exploration of the Preferences of Key Informants. J Appl Gerontol 2021; 41:1002-1010. [PMID: 34905440 DOI: 10.1177/07334648211059056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Navigating the healthcare system is complex. Many older adults and their family members report sub-optimal outcomes when transitioning from hospital to home. Patient navigation has been introduced as a model of care to help improve hospital to home transitions and to better integrate care across care environments. There are no best-practice guidelines for designing a patient navigation program for older adults with complex needs. This qualitative descriptive study interviewed 38 healthcare professionals to determine key characteristics of the "ideal" patient navigator program. Thematic analysis revealed four themes describing key components of an ideal patient navigator program for older adults with complex needs: (1) Easy accessibility and open communication amongst staff; (2) flexible eligibility requirements; (3) characteristics of the patient navigator; and (4) appropriate program size and duration. We suggest directions for future research, program design, and implementation considers to improve patient navigation for older adults and their family caregivers.
Collapse
Affiliation(s)
- Kristina M Kokorelias
- St John's Rehab Research Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Sander L Hitzig
- St John's Rehab Research Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Temerty Faculty of Medicine, Rehabilitation Sciences Institute, 12366University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, 12366University of Toronto, Toronto, Canada
| |
Collapse
|
8
|
A Rapid Realist Review of Quality Care Process Metrics Implementation in Nursing and Midwifery Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211932. [PMID: 34831694 PMCID: PMC8621300 DOI: 10.3390/ijerph182211932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022]
Abstract
Quality measurement initiatives promote quality improvement in healthcare but can be challenging to implement effectively. This paper presents a Rapid Realist Review (RRR) of published literature on Quality Care-Process Metrics (QCP-M) implementation in nursing and midwifery practice. An RRR informed by RAMESES II standards was conducted as an efficient means to synthesize evidence using an expert panel. The review involved research question development, quality appraisal, data extraction, and evidence synthesis. Six program theories summarised below identify the key characteristics that promote positive outcomes in QCP-M implementation. Program Theory 1: Focuses on the evidence base and accessibility of the QCP-M and their ease of use by nurses and midwives working in busy and complex care environments. Program Theory 2: Examines the influence of external factors on QCP-M implementation. Program Theory 3: Relates to existing cultures and systems within clinical sites. Program Theory 4: Relates to nurses’ and midwives’ knowledge and beliefs. Program Theory 5: Builds on the staff theme of Programme Theory four, extending the culture of organizational learning, and highlights the meaningful engagement of nurses and midwives in the implementation process as a key characteristic of success. Program Theory 6: Relates to patient needs. The results provide nursing and midwifery policymakers and professionals with evidence-based program theory that can be translated into action-orientated strategies to help guide successful QCP-M implementation.
Collapse
|
9
|
Lyndon H, Latour JM, Marsden J, Kent B. Designing a nurse-led assessment and care planning intervention to support frail older people in primary care: An e-Delphi study. J Adv Nurs 2021; 78:1031-1043. [PMID: 34626001 PMCID: PMC9291776 DOI: 10.1111/jan.15066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/14/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
Abstract
Aim To identify and establish expert consensus on important and feasible components of a nurse‐led, comprehensive geriatric assessment (CGA)‐based intervention for community‐dwelling older people who live with frailty. Design A three‐round modified e‐Delphi survey. Methods An expert panel of 33 UK specialist older people's, primary and community care nurses participated in the three‐round e‐Delphi survey over a 12‐month period in 2017–2018. Data from round 1 were analysed using content analysis. Descriptive statistics were used in the subsequent two rounds to demonstrate convergence of panel opinion and consensus. Results In round 1, experts proposed 30 CGA components that were combined with six additional components from a literature review and clustered into six domains. In round 2, components were rated for importance and feasibility. Rating scores for importance were high across all domains, with lower scores for feasibility. Round 3 revealed that 36 components achieved consensus on importance and 11 out of 36 components reached consensus on feasibility. Conclusion Based on expert panel opinion, the content of a nurse‐led CGA‐based intervention was established, with the aim of future feasibility testing in a randomized controlled trial. Impact This study provides feasible components of a CGA‐based intervention that can be implemented in clinical practice by nurses in partnership with older people who live with frailty. Following further testing and evaluation, the components have the potential to improve clinical outcomes, maximize independence and improve the quality of life for community‐dwelling frail older people.
Collapse
Affiliation(s)
| | - Jos M Latour
- University of Plymouth, Plymouth, UK.,Curtin University, Perth, Australia
| | | | | |
Collapse
|
10
|
Davis KM, Eckert MC, Hutchinson A, Harmon J, Sharplin G, Shakib S, Caughey GE. Effectiveness of nurse-led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface: A quantitative systematic review. Int J Nurs Stud 2021; 121:103986. [PMID: 34242979 DOI: 10.1016/j.ijnurstu.2021.103986] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Globally, chronic disease is a leading cause of illness, disability and death and an important driver of health system utilization and spending. Continuity of care is a significant component of quality healthcare. However, an association between nurse-led services, interventions, patient outcomes and continuity of care at the primary and secondary interface as an outcome, has not been established for people with chronic disease. OBJECTIVE To identify the effectiveness of nurse-led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface. DESIGN Quantitative systematic review. DATA SOURCES Systematic searches of Medline, Cochrane, Embase, Emcare, JBI and Scopus databases were conducted of studies published between 1946 and May 2019 using the search terms "nurse", "continuity of care" and "chronic disease". REVIEW METHODS Quality of the included studies was assessed using the Cochrane risk of bias tool for randomized controlled trials and Joanna Briggs Institute quality appraisal checklists. A second reviewer screened 10% of full text articles and all articles in critical appraisal. Studies were excluded from the review if they were of poor methodological quality or the description of the effect of the nurse-led service was inadequately reported. RESULTS Fourteen studies were included in the review (n=4,090 participants). All studies incorporated recognized continuity of care interventions. The nurse-led services were associated with fewer hospitalizations, reduced by 2-8.9% and re-admissions reduced by 14.8-51% (n=886). Reporting of positive patient experiences and improvement in symptoms and lifestyle was also evident. An association of nurse-led services with improved continuity of care between primary and secondary health services as an outcome per se could not be concluded. CONCLUSION Nurse-led services for adults provide coordinated interventions that support continuity of care for people with chronic disease in both the primary and secondary healthcare settings that are associated with reduced hospitalizations or readmissions and patient satisfaction. However, the limited use of validated continuity of care outcome measurement tools precluded establishing correlations between interventions, patient outcomes and continuity of care as a specific outcome.
Collapse
Affiliation(s)
- K M Davis
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia.
| | - M C Eckert
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia. https://twitter.com/@DrJoanneHarmon
| | - A Hutchinson
- UniSA, Clinical and Health Sciences, University of South Australia
| | - J Harmon
- UniSA, Clinical and Health Sciences, University of South Australia. https://twitter.com/marioneckert5
| | - G Sharplin
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia
| | - S Shakib
- Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - G E Caughey
- Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| |
Collapse
|
11
|
Nilsen ER, Hollister B, Söderhamn U, Dale B. What matters to older adults? Exploring person-centred care during and after transitions between hospital and home. J Clin Nurs 2021; 31:569-581. [PMID: 34117673 DOI: 10.1111/jocn.15914] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES To explore person-centred care provided to a group of older adults (65+) by understanding their experiences of care received, their participation in care and what matters to them during and after the transition process between hospital and home. BACKGROUND Although facilitating person-centred care (PCC) has gained increasing importance globally over the last few decades, its practical implementation has been challenging. This has caused difficulties in determining its core elements and best practices. Person-centred care aims to deliver healthcare services based on individuals' preferences. Several approaches have been developed to better implement person-centred care practices. The Norwegian transitional and follow-up model, 'Holistic Continuity of Patient Care', chooses the 'What Matters to You?' APPROACH Other approaches include 'Shared Decision Making' and 'Continuity of Care'. DESIGN This study employed a qualitative design. METHODS Individual repeated interviews were conducted among eight participants. A hermeneutic exploratory research method was chosen. The COREQ checklist was followed. RESULTS Three main themes related to person-centred care emerged: what matters in meetings with the individual healthcare worker, mobilising health-promoting capabilities and resources and what matters when being in the organisational healthcare system. CONCLUSION To participate in their own health issues, older people need to be empowered and better informed about the importance and scope of person-centred care. 'What Matters to You?' is a good focus for the direction of care but can lead to a simplified understanding of individuals' preferences. Increased focus on how care recipients' capabilities and resources affect their responding is needed. RELEVANCE TO CLINICAL PRACTICE Ensuring that person-centred aspects are incorporated into the entire healthcare system requires better methods of engaging and empowering older adults in healthcare settings; more focus on PCC competence and skills of healthcare professionals as well as better integration of PCC practices into healthcare administration and policies.
Collapse
Affiliation(s)
- Elin Rogn Nilsen
- Faculty of Health and Sport Sciences, Centre for Caring Research, South, University of Agder, Grimstad, Norway
| | - Brooke Hollister
- Faculty of Health and Sport Sciences, Centre for Caring Research, South, University of Agder, Grimstad, Norway.,Institute for Health & Aging, University of California, San Francisco, San Francisco, CA, USA
| | - Ulrika Söderhamn
- Faculty of Health and Sport Sciences, Centre for Caring Research, South, University of Agder, Grimstad, Norway
| | - Bjørg Dale
- Faculty of Health and Sport Sciences, Centre for Caring Research, South, University of Agder, Grimstad, Norway
| |
Collapse
|
12
|
Monkong S, Krairit O, Ngamkala T, Chonburi JSN, Pussawiro W, Ratchasan P. Transitional care for older people from hospital to home: a best practice implementation project. JBI Evid Synth 2021; 18:357-367. [PMID: 32229738 DOI: 10.11124/jbisrir-d-19-00180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The objective of this implementation project was to promote evidence-based practice of transitional care for older people from hospital to home. INTRODUCTION The transition following hospitalization is a critical period of health risk for older people and their family caregivers. Older people need to learn how to take care of themselves at home safely, and caregivers play an important role in caring for them both in hospital and at home. METHODS A clinical audit was undertaken using evidence-based criteria regarding transitional care. Eight audit criteria that represented best-practice recommendations of transitional care for older people from hospital to home were used. A baseline audit was conducted, followed by the implementation of transitional care strategies, and the project was finalized with a follow-up audit to determine the change in practice. RESULTS Improvements in clinical practice were identified in relation to healthcare professional knowledge regarding transitional care, patient care needs during the transition and a multifaceted approach during the transition phase. CONCLUSIONS The project demonstrated positive changes in the transitional care for older people from hospital to home. A multifaceted approach, including patient-centered discharge instruction, telephone follow-up and family caregiver preparedness, is required for older adults to be successfully discharged from hospital to home.
Collapse
Affiliation(s)
- Supreeda Monkong
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Orapitchaya Krairit
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tipanatre Ngamkala
- Nursing Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Wipawee Pussawiro
- Nursing Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Penny Ratchasan
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
13
|
Keen J, Abdulwahid M, King N, Wright J, Randell R, Gardner P, Waring J, Longo R, Nikolova S, Sloan C, Greenhalgh J. The effects of interoperable information technology networks on patient safety: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Interoperable networks connect information technology systems of different organisations, allowing professionals in one organisation to access patient data held in another one. Health policy-makers in many countries believe that they will improve the co-ordination of services and, hence, the quality of services and patient safety. To the best of our knowledge, there have not been any previous systematic reviews of the effects of these networks on patient safety.
Objectives
The aim of the study was to establish how, why and in what circumstances interoperable information technology networks improved patient safety, failed to do so or increased safety risks. The objectives of the study were to (1) identify programme theories and prioritise theories to review; (2) search systematically for evidence to test the theories; (3) undertake quality appraisal, and use included texts to support, refine or reject programme theories; (4) synthesise the findings; and (5) disseminate the findings to a range of audiences.
Design
Realist synthesis, including consultation with stakeholders in nominal groups and semistructured interviews.
Settings and participants
Following a stakeholder prioritisation process, several domains were reviewed: older people living at home requiring co-ordinated care, at-risk children living at home and medicines reconciliation services for any patients living at home. The effects of networks on services in health economies were also investigated.
Intervention
An interoperable network that linked at least two organisations, including a maximum of one hospital, in a city or region.
Outcomes
Increase, reduction or no change in patients’ risks, such as a change in the risk of taking an inappropriate medication.
Results
We did not find any detailed accounts of the ways in which interoperable networks are intended to work and improve patient safety. Theory fragments were identified and used to develop programme and mid-range theories. There is good evidence that there are problems with the co-ordination of services in each of the domains studied. The implicit hypothesis about interoperable networks is that they help to solve co-ordination problems, but evidence across the domains showed that professionals found interoperable networks difficult to use. There is insufficient evidence about the effectiveness of interoperable networks to allow us to establish how and why they affect patient safety.
Limitations
The lack of evidence about patient-specific measures of effectiveness meant that we were not able to determine ‘what works’, nor any variations in what works, when interoperable networks are deployed and used by health and social care professionals.
Conclusions
There is a dearth of evidence about the effects of interoperable networks on patient safety. It is not clear if the networks are associated with safer treatment and care, have no effects or increase clinical risks.
Future work
Possible future research includes primary studies of the effectiveness of interoperable networks, of economies of scope and scale and, more generally, on the value of information infrastructures.
Study registration
This study is registered as PROSPERO CRD42017073004.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 40. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Justin Keen
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Natalie King
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Peter Gardner
- School of Psychology, University of Leeds, Leeds, UK
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Roberta Longo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Claire Sloan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| |
Collapse
|
14
|
Acosta AM, Lima MADDS, Pinto IC, Weber LAF. Care transition of patients with chronic diseases from the discharge of the emergency service to their homes. ACTA ACUST UNITED AC 2020; 41:e20190155. [PMID: 32401891 DOI: 10.1590/1983-1447.2020.20190155] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/27/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the quality of the care transition for patients with chronic non-communicable diseases discharged from the emergency department to home. METHOD A cross-sectional observational and epidemiological study conducted at an emergency department in the South of Brazil with 117 patients and 81 caregivers. The Care Transitions Measure was applied by phone to collect data. A descriptive and analytical statistical analysis was performed. RESULTS The quality of the care transition's total score was close to satisfactory (69.5). The "Self-Management Training" factor had the highest score (70.6), while "Understanding medications" had the lowest (68.3). Items related to understanding medications and confidence in carrying out care after discharge obtained lower scores. CONCLUSIONS A moderate quality of the care transition was evidenced, as well as the need to adopt strategies to improve the emergency department discharge process and the continuity of the care of patients with chronic diseases.
Collapse
Affiliation(s)
- Aline Marques Acosta
- Departamento de Assistência e Orientação Profissional, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | - Maria Alice Dias da Silva Lima
- Departamento de Assistência e Orientação Profissional, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | - Ione Carvalho Pinto
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Luciana Andressa Feil Weber
- Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| |
Collapse
|
15
|
Allen J, Hutchinson AM, Brown R, Livingston PM. Evaluation of the TRANSITION tool to improve communication during older patients' care transitions: Healthcare practitioners' perspectives. J Clin Nurs 2020; 29:2275-2284. [PMID: 32129530 DOI: 10.1111/jocn.15236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/05/2020] [Accepted: 02/21/2020] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate healthcare practitioners' perceptions of the feasibility and acceptability of a communication tool, entitled the TRANSITION tool, to communicate with older patients during transition from acute care to a community setting. BACKGROUND Transitional care for older patients is challenging due to their complex care needs and rapid care transitions. Research has identified effective models of transitional care. However, optimal communication between healthcare practitioners and older patients remains under-investigated. DESIGN Exploratory descriptive qualitative design. METHODS The methods are reported using the Consolidated Criteria for Reporting Qualitative Studies checklist. The setting comprised two acute medical wards in an urban hospital in Australia. Twenty-two nursing and allied healthcare practitioners used the TRANSITION tool to guide communication about transitional care with an older patient and then participated in an interview about their experience of using the tool. All data were thematically analysed. FINDINGS Healthcare practitioners reported their perceptions that the TRANSITION tool was feasible and acceptable, and that they perceived the tool supported them to know what to ask and to find out information regarding their patient's transitional care needs. Some ward-based nurses reported their perception that transitional care was not their role. CONCLUSIONS Findings emphasise transitional care as a continuing care process that requires effective communication between nurses and older patients in acute medical wards. RELEVANCE TO CLINICAL PRACTICE Given shorter lengths of stay, complex care needs and slow recovery, ward-based nurses are vital in communicating with older patients about their transitional care needs. The TRANSITION tool may support communication between ward-based nurses and older patients to improve assessment and planning. Implementation of the tool will require a planned strategy to facilitate translation of the tool into routine practice of ward-based nurses to support their roles during older patients' care transitions.
Collapse
Affiliation(s)
- Jacqueline Allen
- School of Nursing and Midwifery, Monash University, Clayton, Vic., Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia.,Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, Vic., Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia
| | - Patricia M Livingston
- Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, Vic., Australia.,Faculty of Health, Deakin University, Geelong, Vic., Australia
| |
Collapse
|
16
|
Nilsen ER, Söderhamn U, Dale B. Facilitating holistic continuity of care for older patients: Home care nurses’ experiences using checklists. J Clin Nurs 2019; 28:3478-3491. [DOI: 10.1111/jocn.14940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/16/2019] [Accepted: 05/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Elin R. Nilsen
- Faculty of Health and Sport Sciences, Centre for Caring Research University of Agder Grimstad Norway
| | - Ulrika Söderhamn
- Faculty of Health and Sport Sciences, Centre for Caring Research University of Agder Grimstad Norway
| | - Bjørg Dale
- Faculty of Health and Sport Sciences, Centre for Caring Research University of Agder Grimstad Norway
| |
Collapse
|
17
|
Joshi R, Pakhare A, Kumar S, Khadanga S, Joshi A. Improving the capacity of nurses for non-communicable disease service delivery in India: how do they fare in comparison to doctors? EDUCATION FOR PRIMARY CARE 2019; 30:230-236. [PMID: 31154948 DOI: 10.1080/14739879.2019.1619097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
India has witnessed a major shift in morbidity to non-communicable diseases (NCDs) in the last few decades. The service delivery for these long-term conditions has been physician-centred up till now. There is a recent move towards shared care, and nurses are being engaged in the delivery of NCD care. This study was performed in the context of a composite training initiative involving nurses and doctors. Our aim was to compare the performance of nurses with doctors to determine which skills need to be emphasised in future educational programmes. Baseline and end-training knowledge assessments were available from training records. In 2014, of a total of 387 participants from one state in India, 153 were followed up to assess long-term retention of knowledge in various NCD training domains. We found that despite a lower baseline, nurses had a similar attrition in knowledge after training compared to doctors. Results of our study emphasised that nurses can be trained for the primary care needs of NCDs and that both nurses and doctors have retraining needs.
Collapse
Affiliation(s)
- Rajnish Joshi
- Department of Medicine, All India Institute of Medical Sciences , Bhopal , India
| | - Abhijit Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences , Bhopal , India
| | - Sanjeev Kumar
- Department of Community and Family Medicine, All India Institute of Medical Sciences , Bhopal , India
| | - Sagar Khadanga
- Department of Medicine, All India Institute of Medical Sciences , Bhopal , India
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences , Bhopal , India
| |
Collapse
|
18
|
Eaton CK. Social workers, nurses, or both: Who is primarily responsible for hospital discharge planning with older adults? SOCIAL WORK IN HEALTH CARE 2018; 57:851-863. [PMID: 30300115 DOI: 10.1080/00981389.2018.1521892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study examines the profession primarily responsible for discharge planning in all hospitals serving older adults in Minnesota. Quantitative analyses determined that the majority of hospitals in Minnesota serving older adults are small, rural hospitals with critical access designations, are private nonprofit, and are affiliated with a health care system. Social workers are primarily responsible for discharge planning in half of the hospitals, nurses in a quarter and either a nurse/social worker team or both nurse and social worker separately in the remaining quarter. Multinomial logistic regression determined that in critical access hospitals nurses are more likely than social workers to be the profession primarily responsible for discharge planning.
Collapse
Affiliation(s)
- Charissa K Eaton
- a Department of Social Work , Winona State University , Winona , MN , USA
| |
Collapse
|
19
|
Hahn-Goldberg S, Jeffs L, Troup A, Kubba R, Okrainec K. "We are doing it together"; The integral role of caregivers in a patients' transition home from the medicine unit. PLoS One 2018; 13:e0197831. [PMID: 29795623 PMCID: PMC5993108 DOI: 10.1371/journal.pone.0197831] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022] Open
Abstract
Background An admission to hospital for acute illness can be difficult for patients and lead to high levels of anxiety. Patients are given a lot of information throughout their hospital stay and instructions at discharge to follow when they get home. For complex medical patients, the ability to retain, understand, and adhere to these instructions is a critical marker of a successful transition. This study was undertaken to explore factors impacting the ability of patients to understand and adhere to instructions. Methods A qualitative design of interviews with patients and caregivers was used. Participants were adult patients and caregivers with congestive heart failure, chronic obstructive pulmonary disease, or community-acquired pneumonia being discharged home from three academic acute care hospitals in Ontario, Canada. Semi structured interviews were conducted with participants within one week following their discharge from hospital. Interviews were audiotaped and transcribed. Five independent researchers participated in an iterative process of coding, reviewing, and analyzing the interviews using direct content analysis. Results In total, 27 participants completed qualitative interviews. Analysis revealed the role of the caregiver to be critical in its relation to the ability of patients to understand and adhere to discharge instructions. Within the topic of caregiving, we draw on three areas of insight: The first clarified how caregivers support patients after they are discharged home from the hospital. The second highlighted how caregiver involvement impacts patient understanding and adherence to discharge instructions. The third revealed system factors that influence a caregiver’s involvement when receiving discharge instructions. Conclusion Caregivers play an important role in the transition of a complex medical patient by impacting a patient’s ability to understand and adhere to their discharge instructions. The themes identified in this paper highlight opportunities for healthcare providers and institutions to effectively involve caregivers during transitions from acute care hospitals to home.
Collapse
Affiliation(s)
- Shoshana Hahn-Goldberg
- OpenLab, University Health Network, Toronto, Ontario, Canada
- School of Health Policy and Management, Yok University, Toronto, Ontario, Canada
- * E-mail:
| | - Lianne Jeffs
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Amy Troup
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - Rasha Kubba
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - Karen Okrainec
- University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
20
|
Berenguer-García N, Roldán-Chicano MT, Rodríguez-Tello J, García-López MDM, Dávila-Martínez R, Bueno-García MJ. Validación del cuestionario CTM-3-modificado sobre satisfacción con la continuidad de cuidados: un estudio de cohortes. AQUICHAN 2018. [DOI: 10.5294/aqui.2018.18.1.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivos: validar el contenido y constructo de la encuesta CTM-3 (Care Transitions Measure- 3 preguntas) modificada. Determinar el nivel de satisfacción de los usuarios con la continuidad de cuidados de enfermería interniveles y relacionarlo con la presencia de Informe de Cuidados de Enfermería tras su última hospitalización. Material y método: estudio de cohortes retrospectivo, con 131 pacientes hospitalizados en el Complejo Hospitalario de Cartagena (España).La satisfacción con la continuidad de cuidados se valoró con el cuestionario CTM-3-modificado, resultado de un proceso de validación realizado sobre el mismo. Resultados: un 94% de los encuestados presenta una satisfacción aceptable con el proceso de continuidad de cuidados. Los pacientes con Informe de Cuidados tienen un nivel alto de satisfacción con la continuidad de cuidados, RR= 0,90 (IC 95%: 0,831-0,990). Conclusiones: La validez de contenido y constructo realizadas, han permitido medir la satisfacción de los usuarios con la continuidad y su correlación con la presencia de informe, obteniendo como resultado que la realización de Informe de Cuidados influye ligeramente en la satisfacción con el proceso de continuidad de cuidados. Sin embargo, el hecho de que el informe se entregue en mano y/o se explique no parece afectar a la misma.
Collapse
|
21
|
|
22
|
Jeffs L, Saragosa M, Law M, Kuluski K, Espin S, Merkley J, Bell CM. Elucidating the information exchange during interfacility care transitions: Insights from a Qualitative Study. BMJ Open 2017; 7:e015400. [PMID: 28706095 PMCID: PMC5734419 DOI: 10.1136/bmjopen-2016-015400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the perceptions of patients, their caregivers and healthcare professionals associated with the exchange of information during transitioning from two acute care hospitals to one rehabilitation hospital. DESIGN An exploratory qualitative study using semi-structured interviews and observation. PARTICIPANTS AND SETTING Patients over the age of 65 years admitted to an orthopaedic unit for a non-elective admission, their caregivers and healthcare professionals involved in their care. Participating sites included orthopaedic inpatient units from two acute care teaching hospitals and one orthopaedic unit at a rehabilitation hospital in an urban setting. FINDINGS Three distinct themes emerged from participants' narrative of their transitional care experience: (1) having no clue what the care plan is, (2) being told and notified about the plan and (3) experiencing challenges absorbing information. Participating patients and their caregivers reported not being engaged in an active discussion with healthcare professionals about their care transition plan. Several healthcare professionals described withholding information within the plan until they themselves were clear about the transition outcomes. CONCLUSION This study highlights the need to increase efforts to ensure that effective information exchanges occur during transition from acute care hospital to rehabilitation settings.
Collapse
Affiliation(s)
- Lianne Jeffs
- St Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's, Toronto, Canada
| | - Marianne Saragosa
- St Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's, Toronto, Canada
| | - Madelyn Law
- Department of Health Science, Brock University, St Michael's, Toronto, Canada
| | - Kerry Kuluski
- Community Health Sciences, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Jane Merkley
- Executive Offices, Sinai Health System, Toronto, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
23
|
Scott AM, Li J, Oyewole-Eletu S, Nguyen HQ, Gass B, Hirschman KB, Mitchell S, Hudson SM, Williams MV. Understanding Facilitators and Barriers to Care Transitions: Insights from Project ACHIEVE Site Visits. Jt Comm J Qual Patient Saf 2017; 43:433-447. [PMID: 28844229 DOI: 10.1016/j.jcjq.2017.02.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/20/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Care transitions between clinicians or settings are often fragmented and marked by adverse events. To increase patient safety and deliver more efficient and effective health care, new ways to optimize these transitions need to be identified. A study was conducted to delineate facilitators and barriers to implementation of transitional care services at health systems that may have been adopted or adapted from published evidence-based models. METHODS From March 2015 through December 2015, site visits were conducted across the United States at 22 health care organizations-community hospitals, academic medical centers, integrated health systems, and broader community partnerships. At each site, direct observation and document review were conducted, as were semistructured interviews with a total of 810 participants (5 to 57 participants per site) representing various stakeholder groups, including management and leadership, transitional care team members, internal stakeholders, community partners, patients, and family caregivers. RESULTS Facilitators of effective care transitions included collaborating within and beyond the organization, tailoring care to patients and caregivers, and generating buy-in among staff. Commonly reported barriers included poor integration of transitional care services, unmet patient or caregiver needs, underutilized services, and lack of physician buy-in. CONCLUSION True community partnership, high-quality communication, patient and family engagement, and ongoing evaluation and adaptation of transitional care strategies are ultimately needed to facilitate effective care transitions. Health care organizations can strategically prioritize transitional care service delivery through staffing decisions, by making transitional care part of the organization's formal board agenda, and by incentivizing excellence in providing transitional care services.
Collapse
|
24
|
Jeffs L, Saragosa M, Law MP, Kuluski K, Espin S, Merkley J. The role of caregivers in interfacility care transitions: a qualitative study. Patient Prefer Adherence 2017; 11:1443-1450. [PMID: 28860727 PMCID: PMC5572948 DOI: 10.2147/ppa.s136058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A qualitative design was used to explore the nature of caregiver involvement in care transitions of patients being transferred from an acute care hospital to a rehabilitation hospital. Participants included older adults (n=13), informal caregivers (n=9), and health care professionals (n=50) from inpatient orthopedic units in two academic health science centers and one orthopedic inpatient rehabilitation unit. Semistructured interviews were conducted, audio-taped, and transcribed. Directed content analysis revealed the following four themes: watching, being an active care provider, advocating, and navigating the health care system. Participants described being actively involved in the care of their family member, yet they were not actively engaged by health care professionals to be involved in the care of their family member. There is a need to reconcile the tension between the level of involvement of caregivers in the care of family members who are patients and the level of engagement throughout the care transition. By providing relevant information and authentically engaging caregivers as equal partners in the care transition, they are better able to navigate the health care system post-transfer to the rehabilitation setting and discharge to home.
Collapse
Affiliation(s)
- Lianne Jeffs
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto
- Correspondence: Lianne Jeffs, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Room 720, 209 Victoria Street, Toronto, ON M5B 1T8, Canada, Tel +1 416 864 6060 ext 77644, Email
| | - Marianne Saragosa
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto
| | - Madelyn P Law
- Department of Health Science, Brock University, St Catharines
| | - Kerry Kuluski
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University
| | - Jane Merkley
- Executive Offices, Sinai Health System, Toronto, ON, Canada
| |
Collapse
|